One Stroke every Five Minutes -timing and safety

In the UK there is one person suffering a stroke every five minutes. The perceived medical wisdom surrounding the effective treatment of this potentially fatal, if not highly debilitating event is around 'time to needle' and the use of a clot busting drug called alteplase. Alteplase, sometimes known as tissue plasminogen activator or TPA is a thrombolytic drug that is injected into a vein by reperfusion. Due to the severe side-effects of the drug (including bleeding into the brain) the dose required to treat acute ischaemic stroke requires specialist expertise as it must not exceed 90 mg and has to be infused over an hour.

However, to be effective the drug should be administered as fast as possible, which has coined the term 'door-to-needle' or 'time-to-needle'. Stroke specialists tend to be located in urban areas and so the rate limiting step tends to be the speed at which the patient is brought into the hospital, which for rural communities can be a big challenge when every minute counts.

According to Stroke, researchers conducting a study in rural Bavaria looked at the role for telemedicine - i.e. using technology to evaluate patients remotely and to recommend treatment strategies, which is a pretty obvious way to bring specialist care to rural areas. This required stroke neurologists based in the main hospitals to be on call to evaluate patients brought into community hospitals in distant towns. They report that door-to-needle times were reduced by half and the lag between symptom onset and first treatment by 20%,

There is little doubt that the appropriate application of technology can potentially bring huge benefits to stroke patients, however, timing is not the only critical factor especially as there are now new concerns over the safety of the use of alteplase. The Medicines and Healthcare products Regulatory Agency (MHRA) say that although they believe that the benefits of alteplase outweigh the risks. it is nonetheless revisiting the evidence as some experts say previous assessments may have been flawed.

The MHRA are setting up an expert working group "to ensure all relevant sources of evidence have been taken into consideration".

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